More than 2.8 million antibiotic-resistant infections occur in the U.S. every year, and more than 35,000 people die as a result of those infections, according to a newly released Centers for Disease Control and Prevention (CDC) report.
The updated Antibiotic Resistance Threats in the United States (AR Threats Report) also estimates when antibiotic-resistant bacterium Clostridium difficile (or C. diff) is included, that number exceeds 3 million infections and 48,000 deaths. The report, which used data sources such as electronic health records not previously available, shows that there were nearly twice as many annual deaths from antibiotic-resistant infections as the CDC originally reported in 2013.
CDC officials called the numbers in this report "more precise, though still conservative, estimates of the human costs of antibiotic resistance."
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There is some good news. For starters, there have been fewer infections from five of the germs previously listed as “serious.” Infections from the "urgent" threat of "nightmare bacteria” carbapenem-resistant Enterobacteriaceae (CRE) have remained stable, a noteworthy accomplishment given how quickly the germ spread in the early 2000s, officials said.
The report also estimates prevention efforts have reduced deaths from antibiotic-resistant infections by 18% overall and by 28% in hospitals between 2012 and 2017. They credited drops to efforts such as preventing device- and procedure-related infections, implementing the Containment Strategy to stop the spread of emerging threats and improving antibiotic use in outpatient settings by 5% for the improvement.
“The new AR Threats Report shows us that our collective efforts to stop the spread of germs and preventing infections is saving lives,” said CDC Director Robert Redfield, M.D., in a statement. “The 2013 report propelled the nation toward critical action and investments against antibiotic resistance. Today’s report demonstrates notable progress, yet the threat is still real."
However, the list of 18 germs that have elicited warnings as being an "urgent" threats to human health increased from three to five with the addition of drug-resistant Candida auris and carbapenem-resistant Acinetobacter. Urgent threats also include CRE, Neisseria gonorrhoeae and C. diff.
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The report also identifies three germs that are on a watch list, meaning they have yet to spread resistance widely and are not well understood in the U.S. but are being closely monitored.
Industry response
CDC officials said they are concerned about antibiotic-resistant infections on the rise in communities. For instance, they pointed to a form of drug-resistant gonorrhea infections that has developed resistance to all but one class of antibiotics, with half of all infections resistant to at least one antibiotic.
They also flagged ESBL-producing Enterobacteriaceae, which are one of the leading causes of death from drug-resistant germs and make urinary tract infections harder to treat, particularly in women.
CDC officials said further preventing infections, including getting ahead of sepsis, and stopping the spread of germs will save more lives. The American Medical Association (AMA) said it is working to ensure the appropriate use of antibiotics across healthcare settings and is working to identify gaps and barriers to implementing antibiotic stewardship in outpatient healthcare facilities, officials said.
“While the CDC’s report shows that progress has been made over the past few years to stem antibiotic-resistant infections, it also shines a light on the emerging sources of antibiotic-resistant infections that will continue to threaten public health if not controlled," said AMA President Patrice Harris, M.D. "We must all remain vigilant in combatting the spread of antibiotic-resistant bacteria in both the health care setting and in our communities."
“It is extremely important that we take steps to prevent infections in the first place, this includes following infection control and prevention recommendations and receiving recommended vaccinations. It is also critical to take steps to ensure the appropriate use of antibiotics across all health care settings. To that end, the AMA is currently working to identify gaps and barriers to implementing antibiotic stewardship in outpatient health care facilities," Harris said.
The National Association of County and City Health Officials (NACCHO) said the report illuminated the fact the problem is not going away and requires more resources to fight.
"As new resistance continues to emerge, local health departments are uniquely positioned to work with healthcare and community partners in infection control and containment response," said Lori Tremmel Freeman, NACCHO's CEO, in a statement. "But funding and resources, including additional personnel, are required, as local health departments have lost almost a quarter of their workforce in the last decade. Increased resources are crucial to continuing the gains made to date and responding to the ongoing threat posed by expanding, evolving, and emerging resistant bacteria and fungi.”